Dr. Michael J. Fisch
“Value and cost are among the biggest issues in health care today, but there are few tools to help doctors and patients objectively assess benefits, side effects, and costs,” 2015–2016 ASCO President Julie M. Vose, MD, MBA, FASCO, said in a press release about the publication.2 “Our goal is to help oncologists and their patients weigh potential treatment options based on high-quality scientific evidence and a thoughtful assessment of each patient’s needs and goals. In publishing this initial version of the Framework, which is just the beginning of the process, we hope to drive discussion and debate about a critically important issue.”
According to Michael J. Fisch, MD, MPH, FACP, FAAHPM, of AIM Specialty Health, publication of the Value Framework represents a clear shift in how the oncology community is viewing the ideas of value and quality; a shift from theory to practice.
“This statement was to help ASCO members understand the issues being faced in the United States because of health care costs,” Dr. Fisch told the ASCO Daily News. “Instead of conceptual ideas, people are digging into specifics and evaluating how we might operationalize this Value Framework.”
During the 2016 ASCO Annual Meeting, Dr. Fisch will serve as chair of one of the many Education Sessions that will build upon last year’s focus on value and quality.
“This year we charged [each track] to develop at least one talk specifically focused on value,” said Apar K. Ganti, MD, MBBS, 2016 ASCO Annual Meeting Cancer Education Committee chair. “Many tracks stepped up to the plate and have multiple discussions on the value of cancer care in conjunction with the science of cancer care.”
According to Dr. Ganti, these value-focused sessions will cover topics such as how to tailor individual therapy decisions, controversies regarding decreasing the intensity of treatment, determining how much treatment is enough, and whether we really need to give every patient every treatment available.
“We also have sessions that will incorporate patient-reported outcomes into the discussion in order to reflect the patient’s perception of value,” Dr. Ganti said.
Quality and Technology
Dr. Fisch and his colleagues will address value and quality during an Education Session on June 4, “Using Social Media, Wearables, and Electronic Medical Records to Improve Quality of Cancer Care.”
“If you were to ask someone to come up with 10 words to describe social media, I am not sure that value would come up,” Dr. Fisch said. However, he said, social media is just one of the modern technologic platforms that the health care community is starting to embrace as a method of enhancing value and quality care through increased communication with patients and physician peers. Social media allows oncologists to interact with the world around them. It allows them to connect to each other, find and prioritize literature, and have a healthy exchange with the public about cancer care.
“If you want to influence how people think about cancer care, you are able to do that [through social media],” Dr. Fisch said.
The session will also include a discussion about wearable devices and patient data. Today, not all health care happens when a patient goes to the doctor’s office; care is sometimes delivered at a distance, Dr. Fisch explained.
In the oncology arena, the use of wearables is still in its infancy, but Dr. Fisch said there is an increasing use, especially within the survivorship care arena.
For example, “a patient has finished adjuvant treatment for breast, prostate, or colorectal cancer—three diseases for which obesity is a risk factor for recurrence—and the doctor prescribes physical activity,” Dr. Fisch said. “It is one thing to say, ‘You should start exercising more,’ and another to have technology that can [determine] how much exercise a patient is getting and how many calories they are putting in.”
In addition, patient data taken from wearables may present a new opportunity for research in oncology, allowing for the potential to discover and understand what works in terms of comparative effectiveness.
Dr. Fisch’s session will also discuss the use of electronic medical records to improve quality and safety in oncology care.
“Electronic medical records are increasingly used to measure adherence to quality metrics and are going to be a part of the story of how providers connect with patients at a distance through secure portals,” Dr. Fisch said. “They also have the potential to improve quality of care by enhancing education and awareness of evidence-based guidelines through decision support features.”
Quality and Value
On June 5, two more Education Sessions will address defining and measuring quality in oncology.
Lowell E. Schnipper, MD, FASCO, chair of ASCO’s Value in Cancer Care Task Force and lead author of the Value Framework statement, will chair the session “Quality and Value: Measuring and Utilizing Both in Your Practice.”
Dr. Lowell E. Schnipper
During this session, Dr. Schnipper will provide an overview of the ASCO Value Framework.
“With the Value Framework, we wanted to come up with a mechanism or model that would help us, in a quantifiable way, to look at new offerings for treatment regimens or drugs, and ask, ‘Are they better than what is already out there?’” Dr. Schnipper said. “[The Framework] should [help determine] if the new treatment is better than the standard, if it is more or less toxic than the standard, and if it has any other positive attributes, like relieving symptoms, that add to its perceived value.”
The Value Framework will also encourage discussion on how much new treatments will cost the patient. Dr. Schnipper will also talk about how ASCO’s Value Framework fits into the spectrum of other value guidelines, such as those released by the European Society for Medical Oncology (ESMO). According to Dr. Schnipper, ESMO has released its own formulation on how to quantify value in cancer care, but it does not add cost into the consideration; instead, it only looks at the clinical impact.
Dr. Anne C. Chiang
Another speaker during the session, Anne C. Chiang, MD, PhD, of Yale Cancer Center, will discuss ASCO’s Quality Oncology Practice Initiative (QOPI®). According to Dr. Chiang, oncology practices are increasingly being asked to comply with regulatory mandates that demand improved outcomes and quality in their patient care, most recently the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which was designed to focus on value by incentivizing providers to participate in quality measuring programs.
Dr. Patricia A. Ganz Photo courtesy of Ann Johannsson
During her presentation, Dr. Chiang will discuss QOPI and QCP in more detail, highlighting the growing and changing demographics of practices taking advantage of these programs and how practices are using these tools to provide better quality to their patients.
The second Education Session on measuring quality on June 5 is “Defining and Measuring Quality,” chaired by Patricia A. Ganz, MD, FASCO, of the University of California, Los Angeles.
According to Dr. Ganz, this session will provide an update on some of the current initiatives in the United States that are aimed at improving quality of cancer care, including a 2013 report from the Institute of Medicine (IOM), “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis.”3
“This report laid out a framework for thinking about how we could deliver high-quality cancer care,” Dr. Ganz said. It included recommendations for care that is concordant with a patient’s preferences and perceived value and that incorporates services such as palliative care and psychosocial support.
During her presentation, Dr. Ganz will discuss the IOM recommendations and progress made to date.
Her co-presenters in the session will discuss some of the challenges that surround developing quality metrics in oncology and a payer-led experiment in Michigan that is using collected data from urologists’ offices to identify practice variations and recommendations to increase evidence-based practices and conformity in order to eliminate waste and increase quality.
“We have all become aware of the personal and societal harms of doing things that don’t add value to a patient’s life,” Dr. Ganz said. “These changes are not going to happen overnight. We have to have tools available to discuss these things with patients, and we have to re-learn how to have these conversations with patients.”